Clinic Forms
Listed below are the clinic forms:
Required forms for client files are marked with **
- **Authorization To Release **
- **Authorization To Obtain**
- Summer Busy Schedule
- Fall/Spring Busy Schedule
- **Client Consent**
- Clinic Information Sheet
- Disposition Record
- Sample Oral Examination Form
- **HIPAA Privacy Practices** (give to client)
- **HIPAA Signature Form** (for client file)
- **Initial Referral Information**
- Lesson Plan
- Off-Campus Daily Log
- Recertification Form
- Report Distribution Form (print on blue paper)
- Treatment Plan
- Diagnostic Evaluation Report - Template
- Hearing Screening Form